Quantitation of stromal distortion across the full depth of keratoconic corneas
Abstract
Purpose: This study aimed at gaining new insights into the pathophysiology of keratoconus by providing a comprehensive and quantitative characterization of stromal structural alterations throughout the full thickness of keratoconic corneas and in regions both proximal to and distant from the cone.
Methods: Complementary three-dimensional imaging techniques were combined in a pilot exploratory series of four keratoconic and four control human corneas: clinical spectral-domain optical coherence tomography, highly-resolved line-field confocal optical coherence tomography and second harmonic generation (SHG) microcopy. Several structural metrics were computed from SHG images using automatic image analysis pipelines.
Results: Quantitative SHG imaging revealed striking structural shifts in keratoconic corneas compared to healthy controls. Most notably, we observed a significant rise in normalized striation Endpoints (P = 0.008) and End/Branch ratio (P = 0.015), consistent with the presence of wavy lamellae and the loss of the plywood-like structure found in control corneas. Importantly, these structural markers remained consistent in both the cone and outside the cone regions. Quantitative processing of collagen orientation revealed a single widely-spread orientation as opposed to two main orthogonal orientations in control corneas, and slight shifts in orientation between superimposed lamellae rather than the abrupt changes observed in control corneas.
Conclusions: We provide new quantitative data on the structural alterations associated with keratoconus that could serve as useful biomarkers for earlier detection. Our findings are consistent with a decreased stromal stiffness and an increase in the corneal birefringence. They are also in favor of a global stromal disorder rather than a purely localized disorder.
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BibTeX
@article{kasongo2026quantitation,
title = {{Quantitation of stromal distortion across the full depth of keratoconic corneas}},
author = {Poncia Nyembo Kasongo and Djida Ghoubay and Jean-Marc Allain and Malika Hamrani and Cristina Georgeon and Vincent Borderie and Gaël Latour and Marie-Claire Schanne-Klein},
journal = {Investigative Ophthalmology \& Visual Science},
year = {2026},
month = oct,
doi = {10.1167/iovs.67.12.58},
url = {https://hal.science/hal-05838438v1},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Quantitation of stromal distortion across the full depth of keratoconic corneas
AU - Poncia Nyembo Kasongo
AU - Djida Ghoubay
AU - Jean-Marc Allain
AU - Malika Hamrani
AU - Cristina Georgeon
AU - Vincent Borderie
AU - Gaël Latour
AU - Marie-Claire Schanne-Klein
PY - 2026
DA - 2026/10/23
JO - Investigative Ophthalmology & Visual Science
DO - 10.1167/iovs.67.12.58
UR - https://hal.science/hal-05838438v1
AB - Purpose: This study aimed at gaining new insights into the pathophysiology of keratoconus by providing a comprehensive and quantitative characterization of stromal structural alterations throughout the full thickness of keratoconic corneas and in regions both proximal to and distant from the cone. Methods: Complementary three-dimensional imaging techniques were combined in a pilot exploratory series of four keratoconic and four control human corneas: clinical spectral-domain optical coherence tomography, highly-resolved line-field confocal optical coherence tomography and second harmonic generation (SHG) microcopy. Several structural metrics were computed from SHG images using automatic image analysis pipelines. Results: Quantitative SHG imaging revealed striking structural shifts in keratoconic corneas compared to healthy controls. Most notably, we observed a significant rise in normalized striation Endpoints (P = 0.008) and End/Branch ratio (P = 0.015), consistent with the presence of wavy lamellae and the loss of the plywood-like structure found in control corneas. Importantly, these structural markers remained consistent in both the cone and outside the cone regions. Quantitative processing of collagen orientation revealed a single widely-spread orientation as opposed to two main orthogonal orientations in control corneas, and slight shifts in orientation between superimposed lamellae rather than the abrupt changes observed in control corneas. Conclusions: We provide new quantitative data on the structural alterations associated with keratoconus that could serve as useful biomarkers for earlier detection. Our findings are consistent with a decreased stromal stiffness and an increase in the corneal birefringence. They are also in favor of a global stromal disorder rather than a purely localized disorder.
SN - 0146-0404
SN - 1552-5783
ER -